Problems with my periods

Over the past few months I have become more troubled with my periods. I start cramping 1 week before there is any blood present, then during the period it is like someone is holding a knife in 2 places on the inside of my lower stomach the pain is so intense I cant stand up straight. When urinating it feels like the knifes are twisting it very painful. I cant stand this pain. Midol doesn't touch the pain. What could be wrong?? I hate to go to the ER bleeding but if it keeps on thats where I will be.

[Elaine Brown, MD]

Hi!
You will get better care if you make an appointment at your gynecologist's office, and that's exactly what I think you should do! ( Avoid the ER if possible!)

Without the benefit of a physical exam, making a diagnosis is very difficult, but here are some causes of pelvic pain.

Endometriosis is definitely on the list! The pain from endometriosis is cyclical, starting before the period and continuing through the period.  Generally after the period, there is some temporary relief untl the next cycle.  Endometriosis can affect the bladder, or there is a bladder condition known as interstitial cystitis which can occur with/without endometriosis, and causes similar symptoms.

To diagnose either of these conditions, a minor surgical procedure such as a cystoscopy or laparoscopy is necessary.  They can't be seen on ultrasound.

Another possibility is infection either of the bladder ( urinary tract infection ) or uterus and tubes ( pelivic inflammatory disease/cervicitis).  The diagnosis of these requires cultures of the urine and/or cu;tures taken from the cervix.  A Complete blood count and sedimentation rate are good tests too.

Fibroids, and adhesions are third and fourth on the list respectively. Fibroids can be seen on ultrasound.  Adhesions (internal scar tissue) usually requires a laparoscopic procedure (like endometriosis) for diagnosis and treatment

Finally, the bowel can be the culprit, irritable bowel syndrome can be exacerbated by the hormones involved in the menstrual cycle.

There are other possibilities too, but these are the most common and likely.

One way to avoid surgery is to presume that the problem IS endometriosis, and to try the medications that treat endometriosis. Oral contraceptives are a first line, depot lupron is a second option.  If these medications alleviate the symptoms, they can be continued presumptively without the need for surgery.

Whatever the case, I think a trip to your MD is a VERY GOOD idea.

I hope this is helpful!

Dr B